title: Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: the Multiethnic Cohort Study.
abstract: OBJECTIVE
  To explore an independent association between self-reported sleep duration and cause-specific mortality.
  
  
  METHODS
  Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii.
  
  
  RESULTS
  Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9year follow-up. Shorter (≤5h/day) and longer (≥9h/day) sleepers of both sexes (vs. 7h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00-1.28) for ≤5h/day and 1.22 (95% CI 1.09-1.35) for ≥9h/day among men; and 1.20 (95% CI 1.05-1.36) for ≤5h/day and 1.29 (95% CI 1.13-1.47) for ≥9h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (Phetero 0.53) or among women (Phetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index.
  
  
  CONCLUSIONS
  Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.
authors.affiliation: Cancer Epidemiology Program, University of Hawai'i Cancer Center, Honolulu, HI 96813, USA. Electronic address: yeonju.kim5@gmail.com.
authors.forename: Yeonju
authors.initials: Y
authors.lastname: Kim
authors.forename: Lynne R
authors.initials: LR
authors.lastname: Wilkens
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schembre
authors.forename: Brian E
authors.initials: BE
authors.lastname: Henderson
authors.forename: Laurence N
authors.initials: LN
authors.lastname: Kolonel
authors.forename: Marc T
authors.initials: MT
authors.lastname: Goodman
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012890:Sleep; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Cardiovascular disease; Ethnic groups; Mortality; Prospective studies; Sleep